注意缺陷多动障碍（ADHD）的非兴奋剂治疗。

Nonstimulant Treatments for ADHD.

机构信息

Department of Psychiatry, Division of ADHD, Learning Disabilities, and Related Disorders, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1230, New York, NY 10029, USA; Department of Pediatrics, Division of ADHD, Learning Disabilities, and Related Disorders, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1230, New York, NY 10029, USA.

出版信息

Child Adolesc Psychiatr Clin N Am. 2022 Jul;31(3):417-435. doi: 10.1016/j.chc.2022.03.005. Epub 2022 May 11.

DOI:10.1016/j.chc.2022.03.005

PMID:35697393

Abstract

Nonstimulants have an important role when response or tolerability to psychostimulants is poor, when certain comorbid disorders are present, or if patients prefer nonstimulants. Here, we discuss monotherapy and combined treatment of ADHD and review mechanism of action, pharmacokinetics, efficacy, tolerability, and safety of approved, off-label, and pipeline nonstimulants. We present detailed information regarding the 4 FDA-approved nonstimulant medications-the norepinephrine reuptake inhibitors, atomoxetine and viloxazine extended release, and the α-2 adrenergic agonists, clonidine XR and guanfacine XR. We additionally review evidence regarding the off-label use of a variety of other medications. Variability across and within drug classes in nature of response, approach to titration, and temporal characteristics of treatment allow a nuanced treatment approach for individuals with comorbid disorders and complicated clinical presentations. Availability of nonstimulant medications enhances our opportunity to offer personalized treatment of ADHD across the lifespan.

摘要

当对精神兴奋剂的反应或耐受性差、存在某些合并症或患者更喜欢非兴奋剂时，非兴奋剂具有重要作用。在这里，我们讨论了 ADHD 的单药治疗和联合治疗，并回顾了已批准、非适应证和研究阶段的非兴奋剂的作用机制、药代动力学、疗效、耐受性和安全性。我们提供了有关 4 种 FDA 批准的非兴奋剂药物的详细信息——去甲肾上腺素再摄取抑制剂，托莫西汀和维洛沙嗪缓释剂，以及 α-2 肾上腺素能激动剂，可乐定 XR 和胍法辛 XR。我们还回顾了各种其他药物的非适应证使用证据。药物类别内和之间的反应性质、滴定方法以及治疗的时间特征存在差异，这为合并症和复杂临床表现的个体提供了细致的治疗方法。非兴奋剂药物的可用性增强了我们在整个生命周期内提供 ADHD 个性化治疗的机会。